Department of Digestive Surgery and Surgical Oncology (Department of Surgery II), Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan.
Breast. 2013 Oct;22(5):933-7. doi: 10.1016/j.breast.2013.05.001. Epub 2013 May 29.
This study aims to determine the utility of ultrasonography (US)-guided direct dye-marking of sentinel lymph nodes (SLNs) by real-time virtual sonography (RVS) constructed with three-dimensional (3D) computed tomography (CT)-lymphography (LG).
We identified SLNs in 258 clinically node-negative breast cancer patients using an RVS system to display in real time a virtual multiplanar reconstruction CT image obtained from CT volume data corresponding to the same cross-sectional image from US. CT volume data were obtained using our original 3D CT-LG, which accurately detects SLNs in breast cancer. We then perform US-guided dye-marking close to SLNs using indocyanine green (ICG). Subsequently, indigo carmine blue dye was injected into the subareolar and peritumoral areas around each primary tumor. All patients underwent SLN biopsy and SLN metastases were examined pathologically.
In all 258 patients, we were able to detect the same SLNs visualized on 3D CT-LG, using the RVS system. We detected ICG close to SLNs in 257 of 258 patients (99.6%) during SLN biopsy. In 25 patients (9%), we failed to follow the blue lymphatic route stained by indigo carmine and SLNs were not stained by indigo carmine, but easily detected SLNs by ICG marking.
US-guided direct ICG dye-marking of SLNs using this RVS system seems useful for the detection of SLNs, allowing easy detection of SLNs even when the stained lymphatic route is not followed.
本研究旨在确定通过三维（3D）计算机断层扫描（CT）-淋巴造影（LG）构建的实时虚拟超声（RVS）对前哨淋巴结（SLN）进行超声引导直接染料标记的效用。
我们使用 RVS 系统在 258 例临床淋巴结阴性乳腺癌患者中识别 SLN，该系统实时显示来自与 US 相同横截面图像对应的 CT 容积数据获得的虚拟多平面重建 CT 图像。使用我们原始的 3D CT-LG 获取 CT 容积数据，该方法可准确检测乳腺癌中的 SLN。然后，我们使用吲哚菁绿（ICG）在 SLN 附近进行超声引导染料标记。随后，在每个原发性肿瘤的乳晕下和肿瘤周围区域注射靛胭脂染料。所有患者均接受 SLN 活检，并对 SLN 转移进行病理检查。
在所有 258 例患者中，我们均能够使用 RVS 系统检测到与 3D CT-LG 相同的 SLN。在 258 例 SLN 活检患者中，我们在 257 例（99.6%）患者中成功检测到靠近 SLN 的 ICG。在 25 例（9%）患者中，我们未能追踪到靛胭脂染色的蓝色淋巴管，并且 SLN 未被靛胭脂染色，但很容易通过 ICG 标记检测到 SLN。
使用该 RVS 系统对 SLN 进行超声引导直接 ICG 染料标记似乎有助于检测 SLN，即使未追踪到染色淋巴管，也可以轻松检测到 SLN。
